Guest guest Posted October 19, 2006 Report Share Posted October 19, 2006 I agree – the size of your patient panel is determined after you have become ‘full’. I have been adjusting my panel size downward since I opened 3 years ago – I Initially ‘calculated’ (based on typical 2-3 visits/pt/yr model, and anticipating 30 minute appts) that I should have ~700 pts. But in my practice, more often the appts are 45-60 minutes long, and, as I engage in the IMP stuff (time consuming) to further improve my practice/pt care, I have gradually pared down to 400 pts. I followed Gordon’s advice, and was glad I did. To help you determine when you should close, I recommend monitoring your schedule, and when you are nearly full, start closing the gate. This depends on your rate of growth. If you are growing like mad, then start closing when your schedule is 70-80% full for a couple of weeks. If your growth rate is slower, then start closing when you are 90% full. You can always let people in, but it’s hard to shed them quickly if you are in meltdown mode. Even after you close, you will have people trickle in (‘Could you see my husband, too, pleeeez? You’re the only doctor he trusts…’, etc). A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 19, 2006 Report Share Posted October 19, 2006 Gordon, how many people do you have in your panel? Also, another thing I seem to have trouble managing is that promise of seeing you today. I really do see people today if they want me to, but I think I would prefer to have a day off during the week or if I'm on vacation. I can't tell you how many times I offer 4or 5 appt times and still can't get someone in at a time they like. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 19, 2006 Report Share Posted October 19, 2006 Why is the thought of closing so scary? I know I need to . I have over 1200 pt, avg 6-10 new pt requests daily. I see Avg 16-20 pts a day, and I’m maxed out. But does one close temporarily?, for a few months? I guess the fear (probably irrational) is suddenly the pt count drops. It seems premature to close a panel, when I’ve only been opened at my permanent site for 8 months…. T. Ellsworth, MD 9377 E. Bell Road, Suite 175 sdale, Az 85260 From: [mailto: ] On Behalf Of Eads Sent: Thursday, October 19, 2006 8:22 AM To: Subject: When to close to new pts? I agree – the size of your patient panel is determined after you have become ‘full’. I have been adjusting my panel size downward since I opened 3 years ago – I Initially ‘calculated’ (based on typical 2-3 visits/pt/yr model, and anticipating 30 minute appts) that I should have ~700 pts. But in my practice, more often the appts are 45-60 minutes long, and, as I engage in the IMP stuff (time consuming) to further improve my practice/pt care, I have gradually pared down to 400 pts. I followed Gordon’s advice, and was glad I did. To help you determine when you should close, I recommend monitoring your schedule, and when you are nearly full, start closing the gate. This depends on your rate of growth. If you are growing like mad, then start closing when your schedule is 70-80% full for a couple of weeks. If your growth rate is slower, then start closing when you are 90% full. You can always let people in, but it’s hard to shed them quickly if you are in meltdown mode. Even after you close, you will have people trickle in (‘Could you see my husband, too, pleeeez? You’re the only doctor he trusts…’, etc). A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 19, 2006 Report Share Posted October 19, 2006 Why is the thought of closing so scary? I know I need to . I have over 1200 pt, avg 6-10 new pt requests daily. I see Avg 16-20 pts a day, and I’m maxed out. But does one close temporarily?, for a few months? I guess the fear (probably irrational) is suddenly the pt count drops. It seems premature to close a panel, when I’ve only been opened at my permanent site for 8 months…. T. Ellsworth, MD 9377 E. Bell Road, Suite 175 sdale, Az 85260 From: [mailto: ] On Behalf Of Eads Sent: Thursday, October 19, 2006 8:22 AM To: Subject: When to close to new pts? I agree – the size of your patient panel is determined after you have become ‘full’. I have been adjusting my panel size downward since I opened 3 years ago – I Initially ‘calculated’ (based on typical 2-3 visits/pt/yr model, and anticipating 30 minute appts) that I should have ~700 pts. But in my practice, more often the appts are 45-60 minutes long, and, as I engage in the IMP stuff (time consuming) to further improve my practice/pt care, I have gradually pared down to 400 pts. I followed Gordon’s advice, and was glad I did. To help you determine when you should close, I recommend monitoring your schedule, and when you are nearly full, start closing the gate. This depends on your rate of growth. If you are growing like mad, then start closing when your schedule is 70-80% full for a couple of weeks. If your growth rate is slower, then start closing when you are 90% full. You can always let people in, but it’s hard to shed them quickly if you are in meltdown mode. Even after you close, you will have people trickle in (‘Could you see my husband, too, pleeeez? You’re the only doctor he trusts…’, etc). A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 19, 2006 Report Share Posted October 19, 2006 I've been closed for more than three years and we get calls for new patients every day. As noted by Eads: it is a lot easier to let some slip around the door than to figure out how to manage too many patients. Gordon At 03:56 PM 10/19/2006, you wrote: Why is the thought of closing so scary? I know I need to . I have over 1200 pt, avg 6-10 new pt requests daily. I see Avg 16-20 pts a day, and I’m maxed out. But does one close temporarily?, for a few months? I guess the fear (probably irrational) is suddenly the pt count drops. It seems premature to close a panel, when I’ve only been opened at my permanent site for 8 months…. T. Ellsworth, MD 9377 E. Bell Road, Suite 175 sdale, Az 85260 From: [ mailto: ] On Behalf Of Eads Sent: Thursday, October 19, 2006 8:22 AM To: Subject: When to close to new pts? I agree – the size of your patient panel is determined after you have become ‘full’. I have been adjusting my panel size downward since I opened 3 years ago – I Initially ‘calculated’ (based on typical 2-3 visits/pt/yr model, and anticipating 30 minute appts) that I should have ~700 pts. But in my practice, more often the appts are 45-60 minutes long, and, as I engage in the IMP stuff (time consuming) to further improve my practice/pt care, I have gradually pared down to 400 pts. I followed Gordon’s advice, and was glad I did. To help you determine when you should close, I recommend monitoring your schedule, and when you are nearly full, start closing the gate. This depends on your rate of growth. If you are growing like mad, then start closing when your schedule is 70-80% full for a couple of weeks. If your growth rate is slower, then start closing when you are 90% full. You can always let people in, but it’s hard to shed them quickly if you are in meltdown mode. Even after you close, you will have people trickle in (‘Could you see my husband, too, pleeeez? You’re the only doctor he trusts…’, etc). A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 19, 2006 Report Share Posted October 19, 2006 I've been closed for more than three years and we get calls for new patients every day. As noted by Eads: it is a lot easier to let some slip around the door than to figure out how to manage too many patients. Gordon At 03:56 PM 10/19/2006, you wrote: Why is the thought of closing so scary? I know I need to . I have over 1200 pt, avg 6-10 new pt requests daily. I see Avg 16-20 pts a day, and I’m maxed out. But does one close temporarily?, for a few months? I guess the fear (probably irrational) is suddenly the pt count drops. It seems premature to close a panel, when I’ve only been opened at my permanent site for 8 months…. T. Ellsworth, MD 9377 E. Bell Road, Suite 175 sdale, Az 85260 From: [ mailto: ] On Behalf Of Eads Sent: Thursday, October 19, 2006 8:22 AM To: Subject: When to close to new pts? I agree – the size of your patient panel is determined after you have become ‘full’. I have been adjusting my panel size downward since I opened 3 years ago – I Initially ‘calculated’ (based on typical 2-3 visits/pt/yr model, and anticipating 30 minute appts) that I should have ~700 pts. But in my practice, more often the appts are 45-60 minutes long, and, as I engage in the IMP stuff (time consuming) to further improve my practice/pt care, I have gradually pared down to 400 pts. I followed Gordon’s advice, and was glad I did. To help you determine when you should close, I recommend monitoring your schedule, and when you are nearly full, start closing the gate. This depends on your rate of growth. If you are growing like mad, then start closing when your schedule is 70-80% full for a couple of weeks. If your growth rate is slower, then start closing when you are 90% full. You can always let people in, but it’s hard to shed them quickly if you are in meltdown mode. Even after you close, you will have people trickle in (‘Could you see my husband, too, pleeeez? You’re the only doctor he trusts…’, etc). A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 19, 2006 Report Share Posted October 19, 2006 A lot of us find the thought of “closing” our practices scary. That’s because most docs have the mindset of “got to grow, got to grow, grow bigger, keep growing” as a sign of success. I have “officially” closed my practice about 6 months ago. If anyone calls, they are told that the practice is closed to new patients, but my receptionist will take down the info. I am not closed on any insurance panels yet mostly because of their restrictions and a little out of my laziness. Horizon Blue Cross Blue Shield says I can’t close until my panel has 250 patients or more. Horizon NJ Health (NJ Medicaid HMO) won’t let me “close” until I have 50 patients on my panel. We are waiting, hovering 47-51 so missed the close opportunity. What I plan to do is being listed as " closed to new patients " . Existing patients can stay in the practice if they switch insurance and then I can always “let people in” one at a time if I want. I think it actually makes the practice more desirable for patients to have to be “accepted” or wait to get in. I am accepting certain age range. I have a lot of older, sicker patients and few young and healthy. So the young and healthy are being accepted one at a time. What patients are being told is that we are closed “for now” but they can always check back in 6 months. If I start to see too many openings in the schedule when I look ahead then I will reopen. I don’t know how many official “active” patients I have but there are > 1800 in the system, and based on my PPRNet Practice Report there are almost 790 active patients (seen in the last 12 months). It’s probably more as young, healthy patients may go a year without being seen. Kathy Saradarian, MD Branchville, NJ Solo low-staff practice since 4/03 In practice since 9/90 Practice Partner User since 5/03 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 19, 2006 Report Share Posted October 19, 2006 A lot of us find the thought of “closing” our practices scary. That’s because most docs have the mindset of “got to grow, got to grow, grow bigger, keep growing” as a sign of success. I have “officially” closed my practice about 6 months ago. If anyone calls, they are told that the practice is closed to new patients, but my receptionist will take down the info. I am not closed on any insurance panels yet mostly because of their restrictions and a little out of my laziness. Horizon Blue Cross Blue Shield says I can’t close until my panel has 250 patients or more. Horizon NJ Health (NJ Medicaid HMO) won’t let me “close” until I have 50 patients on my panel. We are waiting, hovering 47-51 so missed the close opportunity. What I plan to do is being listed as " closed to new patients " . Existing patients can stay in the practice if they switch insurance and then I can always “let people in” one at a time if I want. I think it actually makes the practice more desirable for patients to have to be “accepted” or wait to get in. I am accepting certain age range. I have a lot of older, sicker patients and few young and healthy. So the young and healthy are being accepted one at a time. What patients are being told is that we are closed “for now” but they can always check back in 6 months. If I start to see too many openings in the schedule when I look ahead then I will reopen. I don’t know how many official “active” patients I have but there are > 1800 in the system, and based on my PPRNet Practice Report there are almost 790 active patients (seen in the last 12 months). It’s probably more as young, healthy patients may go a year without being seen. Kathy Saradarian, MD Branchville, NJ Solo low-staff practice since 4/03 In practice since 9/90 Practice Partner User since 5/03 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 20, 2006 Report Share Posted October 20, 2006 Do you take down ages and etc when you put them on a list? Can one be selective as far as age range and insurance? T. Ellsworth, MD 9377 E. Bell Road, Suite 175 sdale, Az 85260 From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Thursday, October 19, 2006 2:41 PM To: Subject: RE: When to close to new pts? A lot of us find the thought of “closing” our practices scary. That’s because most docs have the mindset of “got to grow, got to grow, grow bigger, keep growing” as a sign of success. I have “officially” closed my practice about 6 months ago. If anyone calls, they are told that the practice is closed to new patients, but my receptionist will take down the info. I am not closed on any insurance panels yet mostly because of their restrictions and a little out of my laziness. Horizon Blue Cross Blue Shield says I can’t close until my panel has 250 patients or more. Horizon NJ Health (NJ Medicaid HMO) won’t let me “close” until I have 50 patients on my panel. We are waiting, hovering 47-51 so missed the close opportunity. What I plan to do is being listed as " closed to new patients " . Existing patients can stay in the practice if they switch insurance and then I can always “let people in” one at a time if I want. I think it actually makes the practice more desirable for patients to have to be “accepted” or wait to get in. I am accepting certain age range. I have a lot of older, sicker patients and few young and healthy. So the young and healthy are being accepted one at a time. What patients are being told is that we are closed “for now” but they can always check back in 6 months. If I start to see too many openings in the schedule when I look ahead then I will reopen. I don’t know how many official “active” patients I have but there are > 1800 in the system, and based on my PPRNet Practice Report there are almost 790 active patients (seen in the last 12 months). It’s probably more as young, healthy patients may go a year without being seen. Kathy Saradarian, MD Branchville, NJ Solo low-staff practice since 4/03 In practice since 9/90 Practice Partner User since 5/03 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 20, 2006 Report Share Posted October 20, 2006 I have "closed" several times - first to the insurance companies, so that they can't randomly assign patients to me. When I felt overwhelmed, I would also close to word of mouth patients, then reopen when things got slow. I usually have kept open to family members of people I'm seeing, but I've even stopped that, as I got about 5 % too busy in the last 6 months. Why is the thought of closing so scary? I know I need to . I have over 1200 pt, avg 6-10 new pt requests daily. I see Avg 16-20 pts a day, and I’m maxed out. But does one close temporarily?, for a few months? I guess the fear (probably irrational) is suddenly the pt count drops. It seems premature to close a panel, when I’ve only been opened at my permanent site for 8 months…. T. Ellsworth, MD9377 E. Bell Road, Suite 175sdale, Az 85260From: [mailto: ] On Behalf Of EadsSent: Thursday, October 19, 2006 8:22 AMTo: Subject: When to close to new pts? I agree – the size of your patient panel is determined after you have become ‘full’. I have been adjusting my panel size downward since I opened 3 years ago – I Initially ‘calculated’ (based on typical 2-3 visits/pt/yr model, and anticipating 30 minute appts) that I should have ~700 pts. But in my practice, more often the appts are 45-60 minutes long, and, as I engage in the IMP stuff (time consuming) to further improve my practice/pt care, I have gradually pared down to 400 pts. I followed Gordon’s advice, and was glad I did. To help you determine when you should close, I recommend monitoring your schedule, and when you are nearly full, start closing the gate. This depends on your rate of growth. If you are growing like mad, then start closing when your schedule is 70-80% full for a couple of weeks. If your growth rate is slower, then start closing when you are 90% full. You can always let people in, but it’s hard to shed them quickly if you are in meltdown mode. Even after you close, you will have people trickle in (‘Could you see my husband, too, pleeeez? You’re the only doctor he trusts…’, etc). A. Eads, M.D.Pinnacle Family Medicine, PLLC phone faxP.O. Box 7275Woodland Park, CO 80863 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 20, 2006 Report Share Posted October 20, 2006 I have all of a sudden jumped to 19-22 patients a day which is definitely more than I am comfortable with. My target is about 17 ( I have an MA). It seemed to have happened so suddenly. After 2 years of trying so hard to build a practice it is very hard to suddenly close. I have decided to stop accepting the bottom 3 insurance companies as a way to decrease my patient load. These comprise about 25-30% of my practice. I am unsure how many people will see me and pay cash. A lot of the insurance companies drive me crazy. One our our biggest payors is United which I am dropping. I think that every one has heard of the problems people have had with United. I think that a lot of people will pay cash for superior service but it is such an unknown. I am sending out almost 400 letters to patients this week letting them know that I am dropping their insurance as of January 1st and am extremely anxious with this move toward a more cash based practice. As an economic move it seemed to me to better to control the volume of patients by dropping insurances rather than just closing my practice but since I don't know how patients will continue with me even though they have to pay pay cash it makes planning very difficultLarry Lindeman MDWhy is the thought of closing so scary? I know I need to . I have over 1200 pt, avg 6-10 new pt requests daily. I see Avg 16-20 pts a day, and I’m maxed out. But does one close temporarily?, for a few months? I guess the fear (probably irrational) is suddenly the pt count drops. It seems premature to close a panel, when I’ve only been opened at my permanent site for 8 months…. T. Ellsworth, MD9377 E. Bell Road, Suite 175sdale, Az 85260From: [mailto: ] On Behalf Of EadsSent: Thursday, October 19, 2006 8:22 AMTo: Subject: When to close to new pts? I agree – the size of your patient panel is determined after you have become ‘full’. I have been adjusting my panel size downward since I opened 3 years ago – I Initially ‘calculated’ (based on typical 2-3 visits/pt/yr model, and anticipating 30 minute appts) that I should have ~700 pts. But in my practice, more often the appts are 45-60 minutes long, and, as I engage in the IMP stuff (time consuming) to further improve my practice/pt care, I have gradually pared down to 400 pts. I followed Gordon’s advice, and was glad I did. To help you determine when you should close, I recommend monitoring your schedule, and when you are nearly full, start closing the gate. This depends on your rate of growth. If you are growing like mad, then start closing when your schedule is 70-80% full for a couple of weeks. If your growth rate is slower, then start closing when you are 90% full. You can always let people in, but it’s hard to shed them quickly if you are in meltdown mode. Even after you close, you will have people trickle in (‘Could you see my husband, too, pleeeez? You’re the only doctor he trusts…’, etc). A. Eads, M.D.Pinnacle Family Medicine, PLLC phone faxP.O. Box 7275Woodland Park, CO 80863 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 20, 2006 Report Share Posted October 20, 2006 Larry, I feel for the difficulty you have sending that letter. However, I definitely believe that until we stop being willing to accept contracts that aren't good for us or our patients, the system won't change very much. So, I think you are making the right move. I'm sure the cash flow unknowns are also a challenge. Good luck and keep us posted. Sharon At 07:23 PM 10/19/2006, you wrote: I have all of a sudden jumped to 19-22 patients a day which is definitely more than I am comfortable with. My target is about 17 ( I have an MA). It seemed to have happened so suddenly. After 2 years of trying so hard to build a practice it is very hard to suddenly close. I have decided to stop accepting the bottom 3 insurance companies as a way to decrease my patient load. These comprise about 25-30% of my practice. I am unsure how many people will see me and pay cash. A lot of the insurance companies drive me crazy. One our our biggest payors is United which I am dropping. I think that every one has heard of the problems people have had with United. I think that a lot of people will pay cash for superior service but it is such an unknown. I am sending out almost 400 letters to patients this week letting them know that I am dropping their insurance as of January 1st and am extremely anxious with this move toward a more cash based practice. As an economic move it seemed to me to better to control the volume of patients by dropping insurances rather than just closing my practice but since I don't know how patients will continue with me even though they have to pay pay cash it makes planning very difficult Larry Lindeman MD Why is the thought of closing so scary? I know I need to . I have over 1200 pt, avg 6-10 new pt requests daily. I see Avg 16-20 pts a day, and I’m maxed out. But does one close temporarily?, for a few months? I guess the fear (probably irrational) is suddenly the pt count drops. It seems premature to close a panel, when I’ve only been opened at my permanent site for 8 months…. T. Ellsworth, MD 9377 E. Bell Road, Suite 175 sdale, Az 85260 From: [mailto: ] On Behalf Of Eads Sent: Thursday, October 19, 2006 8:22 AM To: Subject: When to close to new pts? I agree – the size of your patient panel is determined after you have become ‘full’. I have been adjusting my panel size downward since I opened 3 years ago – I Initially ‘calculated’ (based on typical 2-3 visits/pt/yr model, and anticipating 30 minute appts) that I should have ~700 pts. But in my practice, more often the appts are 45-60 minutes long, and, as I engage in the IMP stuff (time consuming) to further improve my practice/pt care, I have gradually pared down to 400 pts. I followed Gordon’s advice, and was glad I did. To help you determine when you should close, I recommend monitoring your schedule, and when you are nearly full, start closing the gate. This depends on your rate of growth. If you are growing like mad, then start closing when your schedule is 70-80% full for a couple of weeks. If your growth rate is slower, then start closing when you are 90% full. You can always let people in, but it’s hard to shed them quickly if you are in meltdown mode. Even after you close, you will have people trickle in (‘Could you see my husband, too, pleeeez? You’re the only doctor he trusts…’, etc). A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax Fpßÿÿÿÿx5 P.O. Box 7275 Woodland Park, CO 80863 No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.0.408 / Virus Database: 268.13.6/487 - Release Date: 10/19/2006 No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.0.408 / Virus Database: 268.13.6/487 - Release Date: 10/19/2006 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 20, 2006 Report Share Posted October 20, 2006 It is funny how insurances are viewed in different locales. Here, UHC is not so bad from my perspective but Anthem BCBS is horrible & would be right up there with Medicaid on the drop list around here. But yes, I agree that pruning down low payors is the answer & not closing altogether. When to close to new pts? I agree – the size of your patient panel is determined after you have become ‘full’. I have been adjusting my panel size downward since I opened 3 years ago – I Initially ‘calculated’ (based on typical 2-3 visits/pt/yr model, and anticipating 30 minute appts) that I should have ~700 pts. But in my practice, more often the appts are 45-60 minutes long, and, as I engage in the IMP stuff (time consuming) to further improve my practice/pt care, I have gradually pared down to 400 pts. I followed Gordon’s advice, and was glad I did. To help you determine when you should close, I recommend monitoring your schedule, and when you are nearly full, start closing the gate. This depends on your rate of growth. If you are growing like mad, then start closing when your schedule is 70-80% full for a couple of weeks. If your growth rate is slower, then start closing when you are 90% full. You can always let people in, but it’s hard to shed them quickly if you are in meltdown mode. Even after you close, you will have people trickle in (‘Could you see my husband, too, pleeeez? You’re the only doctor he trusts…’, etc). A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 20, 2006 Report Share Posted October 20, 2006 I have also thought, should I just hire an MA and keep going…but only briefly. Because than I would be falling into the trap of bigger, more levels of management, etc. Thanks to everyone’s input, I am going to close till the end of the year as a trial run….and its still scary. T. Ellsworth, MD 9377 E. Bell Road, Suite 175 sdale, Az 85260 From: [mailto: ] On Behalf Of Larry Lindeman Sent: Thursday, October 19, 2006 7:23 PM To: Subject: Re: When to close to new pts? I have all of a sudden jumped to 19-22 patients a day which is definitely more than I am comfortable with. My target is about 17 ( I have an MA). It seemed to have happened so suddenly. After 2 years of trying so hard to build a practice it is very hard to suddenly close. I have decided to stop accepting the bottom 3 insurance companies as a way to decrease my patient load. These comprise about 25-30% of my practice. I am unsure how many people will see me and pay cash. A lot of the insurance companies drive me crazy. One our our biggest payors is United which I am dropping. I think that every one has heard of the problems people have had with United. I think that a lot of people will pay cash for superior service but it is such an unknown. I am sending out almost 400 letters to patients this week letting them know that I am dropping their insurance as of January 1st and am extremely anxious with this move toward a more cash based practice. As an economic move it seemed to me to better to control the volume of patients by dropping insurances rather than just closing my practice but since I don't know how patients will continue with me even though they have to pay pay cash it makes planning very difficult Larry Lindeman MD Why is the thought of closing so scary? I know I need to . I have over 1200 pt, avg 6-10 new pt requests daily. I see Avg 16-20 pts a day, and I’m maxed out. But does one close temporarily?, for a few months? I guess the fear (probably irrational) is suddenly the pt count drops. It seems premature to close a panel, when I’ve only been opened at my permanent site for 8 months…. T. Ellsworth, MD 9377 E. Bell Road, Suite 175 sdale, Az 85260 From: [mailto: ] On Behalf Of Eads Sent: Thursday, October 19, 2006 8:22 AM To: Subject: When to close to new pts? I agree – the size of your patient panel is determined after you have become ‘full’. I have been adjusting my panel size downward since I opened 3 years ago – I Initially ‘calculated’ (based on typical 2-3 visits/pt/yr model, and anticipating 30 minute appts) that I should have ~700 pts. But in my practice, more often the appts are 45-60 minutes long, and, as I engage in the IMP stuff (time consuming) to further improve my practice/pt care, I have gradually pared down to 400 pts. I followed Gordon’s advice, and was glad I did. To help you determine when you should close, I recommend monitoring your schedule, and when you are nearly full, start closing the gate. This depends on your rate of growth. If you are growing like mad, then start closing when your schedule is 70-80% full for a couple of weeks. If your growth rate is slower, then start closing when you are 90% full. You can always let people in, but it’s hard to shed them quickly if you are in meltdown mode. Even after you close, you will have people trickle in (‘Could you see my husband, too, pleeeez? You’re the only doctor he trusts…’, etc). A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 20, 2006 Report Share Posted October 20, 2006 Three months ago, I closed my panel to all new patients except for family members of existing patients, and I am REALLY GLAD about it. With the first 3 patients that called, I felt guilty turning them away, but now I am EXULTANT. New patients are a LOT of work- you have to train each other to the proper behavioral responses, prove yourself (accessibility, qualifications, compassion) over and over again, read and extract old records, etc. I feel much lighter and almost caught up on lots of stuff that was just hanging around. I've got time now to improve on my processes and keep honing my efficiencies. I kept a small waiting list over the past few months of people that would not be turned away and have called about 1/2 of them and they are trickling in now. It was definitely a selective list of patients- I refuse to take any more United insureds- and older people generally needed something at the time they called, so I didn't take any more of them either, just gave them the names of colleagues that I know are taking new patients. The volume and income may have slowed down a bit , but that's OK with me. I'd rather be poor and unstressed than rich and frenetic, any day. I'm probably about at 75% of my desired volume (30 visits a week) but I am going to grow the practice slowly and at my pace (currently about 700 active, maybe will reach 1000 active). When you close, people don't stop calling- I'm still getting about 5 calls a week, WOM and referrals from specialists/other professionals. Wish there was another IMP here to hand them off to... So don't worry about closing, it's a great feeling! Lynn > >Reply-To: >To: < > >Subject: RE: When to close to new pts? >Date: Thu, 19 Oct 2006 12:56:04 -0700 > >Why is the thought of closing so scary? I know I need to . I have over 1200 >pt, avg 6-10 new pt requests daily. I see Avg 16-20 pts a day, and I'm >maxed out. But does one close temporarily?, for a few months? I guess the >fear (probably irrational) is suddenly the pt count drops. It seems >premature to close a panel, when I've only been opened at my permanent site >for 8 months.. > > > > T. Ellsworth, MD > >9377 E. Bell Road, Suite 175 > >sdale, Az 85260 > > _____ > >From: >[mailto: ] On Behalf Of Eads >Sent: Thursday, October 19, 2006 8:22 AM >To: >Subject: When to close to new pts? > > > >I agree - the size of your patient panel is determined after you have >become >'full'. I have been adjusting my panel size downward since I opened 3 >years >ago - I Initially 'calculated' (based on typical 2-3 visits/pt/yr model, >and >anticipating 30 minute appts) that I should have ~700 pts. But in my >practice, more often the appts are 45-60 minutes long, and, as I engage in >the IMP stuff (time consuming) to further improve my practice/pt care, I >have gradually pared down to 400 pts. > > > >I followed Gordon's advice, and was glad I did. To help you determine when >you should close, I recommend monitoring your schedule, and when you are >nearly full, start closing the gate. This depends on your rate of growth. >If you are growing like mad, then start closing when your schedule is >70-80% >full for a couple of weeks. If your growth rate is slower, then start >closing when you are 90% full. You can always let people in, but it's hard >to shed them quickly if you are in meltdown mode. Even after you close, >you >will have people trickle in ('Could you see my husband, too, pleeeez? >You're the only doctor he trusts.', etc). > > > > A. Eads, M.D. > >Pinnacle Family Medicine, PLLC > > phone fax > >P.O. Box 7275 > >Woodland Park, CO 80863 > > > > > _________________________________________________________________ Get today's hot entertainment gossip http://movies.msn.com/movies/hotgossip?icid=T002MSN03A07001 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2006 Report Share Posted October 21, 2006 Thank you, I just read your last post to my office manager/everything person. T. Ellsworth, MD 9377 E. Bell Road, Suite 175 sdale, Az 85260 From: [mailto: ] On Behalf Of lynn ho Sent: Friday, October 20, 2006 3:00 PM To: Subject: RE: When to close to new pts? Three months ago, I closed my panel to all new patients except for family members of existing patients, and I am REALLY GLAD about it. With the first 3 patients that called, I felt guilty turning them away, but now I am EXULTANT. New patients are a LOT of work- you have to train each other to the proper behavioral responses, prove yourself (accessibility, qualifications, compassion) over and over again, read and extract old records, etc. I feel much lighter and almost caught up on lots of stuff that was just hanging around. I've got time now to improve on my processes and keep honing my efficiencies. I kept a small waiting list over the past few months of people that would not be turned away and have called about 1/2 of them and they are trickling in now. It was definitely a selective list of patients- I refuse to take any more United insureds- and older people generally needed something at the time they called, so I didn't take any more of them either, just gave them the names of colleagues that I know are taking new patients. The volume and income may have slowed down a bit , but that's OK with me. I'd rather be poor and unstressed than rich and frenetic, any day. I'm probably about at 75% of my desired volume (30 visits a week) but I am going to grow the practice slowly and at my pace (currently about 700 active, maybe will reach 1000 active). When you close, people don't stop calling- I'm still getting about 5 calls a week, WOM and referrals from specialists/other professionals. Wish there was another IMP here to hand them off to... So don't worry about closing, it's a great feeling! Lynn >From: " Ellsworth " <jellsworth92> >Reply-To: >To: < > >Subject: RE: When to close to new pts? >Date: Thu, 19 Oct 2006 12:56:04 -0700 > >Why is the thought of closing so scary? I know I need to . I have over 1200 >pt, avg 6-10 new pt requests daily. I see Avg 16-20 pts a day, and I'm >maxed out. But does one close temporarily?, for a few months? I guess the >fear (probably irrational) is suddenly the pt count drops. It seems >premature to close a panel, when I've only been opened at my permanent site >for 8 months.. > > > > T. Ellsworth, MD > >9377 E. Bell Road, Suite 175 > >sdale, Az 85260 > > _____ > >From: >[mailto: ] On Behalf Of Eads >Sent: Thursday, October 19, 2006 8:22 AM >To: >Subject: When to close to new pts? > > > >I agree - the size of your patient panel is determined after you have >become >'full'. I have been adjusting my panel size downward since I opened 3 >years >ago - I Initially 'calculated' (based on typical 2-3 visits/pt/yr model, >and >anticipating 30 minute appts) that I should have ~700 pts. But in my >practice, more often the appts are 45-60 minutes long, and, as I engage in >the IMP stuff (time consuming) to further improve my practice/pt care, I >have gradually pared down to 400 pts. > > > >I followed Gordon's advice, and was glad I did. To help you determine when >you should close, I recommend monitoring your schedule, and when you are >nearly full, start closing the gate. This depends on your rate of growth. >If you are growing like mad, then start closing when your schedule is >70-80% >full for a couple of weeks. If your growth rate is slower, then start >closing when you are 90% full. You can always let people in, but it's hard >to shed them quickly if you are in meltdown mode. Even after you close, >you >will have people trickle in ('Could you see my husband, too, pleeeez? >You're the only doctor he trusts.', etc). > > > > A. Eads, M.D. > >Pinnacle Family Medicine, PLLC > > phone fax > >P.O. Box 7275 > >Woodland Park, CO 80863 > > > > > __________________________________________________________ Get today's hot entertainment gossip http://movies.msn.com/movies/hotgossip?icid=T002MSN03A07001 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2006 Report Share Posted October 21, 2006 were you far enough out of Columbus to be part of the Dayton and Cincinnati contract that actually blended the 99213 and 99214? I take both Anthem and UHC. Anthem pays me separately for these codes, they pay for well visit and e+m with modifier 25, they pay well for immunizations, omt and small surgical procedures. UHC never pays for well with sick, didn't pay me for a two month period because of their mistake (this is money I will never see) pays crappy for immunizations and unfortunately is the insurer for most of this part of the city, so 60% of my patients have it. Both insurers are huge, loaded with red tape and bureaucracy (I wish patients understood that this is how health care premiums are spent) and impossible to negotiate with. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2006 Report Share Posted October 21, 2006 As soon as I start to think my practice is close to capacity & the schedule is pretty full, I will have several days in a row of only seeing 6-8 patients (goal: 12-17/day consistently). That is why I'm not a big fan of " closing sooner rather than later. " Maybe people just don't visit the doctor as often where I work (?they can not afford to?). Also, new visits may be a lot of work but they also pay significantly more. I'd rather prune down all low payors before ever considering closing altogether. I do not believe any primary care docs in my community are closed to new patients. > > > Date: 2006/10/20 Fri PM 05:59:52 EDT > To: > Subject: RE: When to close to new pts? > > > Three months ago, I closed my panel to all new patients except for family > members of existing patients, and I am REALLY GLAD about it. With the first > 3 patients that called, I felt guilty turning them away, but now I am > EXULTANT. New patients are a LOT of work- you have to train each other to > the proper behavioral responses, prove yourself (accessibility, > qualifications, compassion) over and over again, read and extract old > records, etc. I feel much lighter and almost caught up on lots of stuff > that was just hanging around. I've got time now to improve on my processes > and keep honing my efficiencies. I kept a small waiting list over the past > few months of people that would not be turned away and have called about 1/2 > of them and they are trickling in now. It was definitely a selective list > of patients- I refuse to take any more United insureds- and older people > generally needed something at the time they called, so I didn't take any > more of them either, just gave them the names of colleagues that I know are > taking new patients. The volume and income may have slowed down a bit , but > that's OK with me. I'd rather be poor and unstressed than rich and > frenetic, any day. I'm probably about at 75% of my desired volume (30 > visits a week) but I am going to grow the practice slowly and at my pace > (currently about 700 active, maybe will reach 1000 active). > When you close, people don't stop calling- I'm still getting about 5 calls > a week, WOM and referrals from specialists/other professionals. Wish there > was another IMP here to hand them off to... > > So don't worry about closing, it's a great feeling! > > Lynn > > > > > >Reply-To: > >To: < > > >Subject: RE: When to close to new pts? > >Date: Thu, 19 Oct 2006 12:56:04 -0700 > > > >Why is the thought of closing so scary? I know I need to . I have over 1200 > >pt, avg 6-10 new pt requests daily. I see Avg 16-20 pts a day, and I'm > >maxed out. But does one close temporarily?, for a few months? I guess the > >fear (probably irrational) is suddenly the pt count drops. It seems > >premature to close a panel, when I've only been opened at my permanent site > >for 8 months.. > > > > > > > > T. Ellsworth, MD > > > >9377 E. Bell Road, Suite 175 > > > >sdale, Az 85260 > > > > _____ > > > >From: > >[mailto: ] On Behalf Of Eads > >Sent: Thursday, October 19, 2006 8:22 AM > >To: > >Subject: When to close to new pts? > > > > > > > >I agree - the size of your patient panel is determined after you have > >become > >'full'. I have been adjusting my panel size downward since I opened 3 > >years > >ago - I Initially 'calculated' (based on typical 2-3 visits/pt/yr model, > >and > >anticipating 30 minute appts) that I should have ~700 pts. But in my > >practice, more often the appts are 45-60 minutes long, and, as I engage in > >the IMP stuff (time consuming) to further improve my practice/pt care, I > >have gradually pared down to 400 pts. > > > > > > > >I followed Gordon's advice, and was glad I did. To help you determine when > >you should close, I recommend monitoring your schedule, and when you are > >nearly full, start closing the gate. This depends on your rate of growth. > >If you are growing like mad, then start closing when your schedule is > >70-80% > >full for a couple of weeks. If your growth rate is slower, then start > >closing when you are 90% full. You can always let people in, but it's hard > >to shed them quickly if you are in meltdown mode. Even after you close, > >you > >will have people trickle in ('Could you see my husband, too, pleeeez? > >You're the only doctor he trusts.', etc). > > > > > > > > A. Eads, M.D. > > > >Pinnacle Family Medicine, PLLC > > > > phone fax > > > >P.O. Box 7275 > > > >Woodland Park, CO 80863 > > > > > > > > > > > > _________________________________________________________________ > Get today's hot entertainment gossip > http://movies.msn.com/movies/hotgossip?icid=T002MSN03A07001 > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2006 Report Share Posted October 21, 2006 No, Anthem did not blend codes here. Anthem is just about the only major plan I do not take. They seemed to routinely create a " fight " to pay things. They require notes be sent automatically before they will even cover a level 5 visit. The blending was just one example of their mentality towards us. I've had no problems with UHC, but your issues are moot for me: I do not generally code a preventive plus ill visit together (I make it two separate visits), I do not give shots anymore, & all my payors reimburse OMT well. Yes, UHC is huge out here too. > > From: mkcl6@... > Date: 2006/10/21 Sat AM 08:15:43 EDT > To: > Subject: Re: When to close to new pts? > > were you far enough out of Columbus to be part of the Dayton an > Cincinnati contract that actually blended the 99213 and 99214? I take both Anthem > and UHC. Anthem pays me separately for these codes, they pay for well visit > and e+m with modifier 25, they pay well for immunizations, omt and small > surgical procedures. UHC never pays for well with sick, didn't pay me for a two > month period because of their mistake (this is money I will never see) pays > crappy for immunizations and unfortunately is the insurer for most of this > part of the city, so 60% of my patients have it. Both insurers are huge, loaded > with red tape and bureaucracy (I wish patients understood that this is how > health care premiums are spent) and impossible to negotiate with. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2006 Report Share Posted October 21, 2006 I think from a customer service point of view it is important to take care of medical problems at preventive visits. I have several patients who make it clear they appreciate this. Many have complained about others who require them to come back for a second visit to take care of GERD or allergies etc... I think it might be a good idea to evaluate where you stand from a customer service perspective, in this and other arenas, especially if you are having a difficult time reaching your targets for patient visits. . Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 21, 2006 Report Share Posted October 21, 2006 I think from a customer service point of view it is important to take care of medical problems at preventive visits. I have several patients who make it clear they appreciate this. Many have complained about others who require them to come back for a second visit to take care of GERD or allergies etc... I think it might be a good idea to evaluate where you stand from a customer service perspective, in this and other arenas, especially if you are having a difficult time reaching your targets for patient visits. . Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2006 Report Share Posted October 23, 2006 In realty, I do it the opposite way: I take care of most of the " preventive " stuff during regular visits. I rarely do " well visits. " As I've said here many times, you will still be held liable for the preventive stuff regardless of whether a patient ever requests a " physical " so you better make sure those things are covered (ie, mammogram in a 45 year old woman). If you wait to address those things until the annual physical (that ight never come) you might get into trouble if something is missed. I just think those screenings, etc can be handled as you go rather than in separate " preventive visits, but that is just me. > From: mkcl6@... > Date: 2006/10/21 Sat PM 06:01:01 EDT > To: > Subject: Re: When to close to new pts? > > I think from a customer service point of view it is important to take care > of medical problems at preventive visits. I have several patients who make it > clear they appreciate this. Many have complained about others who require > them to come back for a second visit to take care of GERD or allergies etc... > I think it might be a good idea to evaluate where you stand from a customer > service perspective, in this and other arenas, especially if you are having a > difficult time reaching your targets for patient visits. . > > Quote Link to comment Share on other sites More sharing options...
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